Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Interstitial lung disease (ILD) is a leading cause of death in patients with rheumatoid arthritis (RA). In end-stage RA-ILD, lung transplant becomes the only option for these patients. However, there are concerns about worse outcomes and a higher risk of allograft dysfunction in patients with RA after lung transplantation due to the underlying immune dysregulation in this population. The main aim was to assess post-transplant survival in patients with RA-ILD compared with patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included rate of acute rejection and chronic rejection.
Methods: Single center study in a referral center for lung transplant of all patients with RA-ILD who underwent lung transplantation from 2008 to 2017 compared with a control group of patients with IPF matched for age, transplant year and basiliximab induction. Cumulative survival rates after lung transplantation were estimated by the Kaplan-Meier method and compared between groups using the log-rank test. Distributions of categorical variables were compared by Pearson Chi2 or Fisher exact test as appropriate.
Results: Patients with RA-ILD (n=9) had similar baseline characteristics than IPF patients (n=9) which are shown in the TABLE. All patients with RA showed the histological subtype of usual interstitial pneumonia. RA-ILD patients tended to experience acute graft rejection less commonly than those with IPF (77.8% vs 44.4%; p=0.34). However, a non-statistically significant increased frequency of chronic graft rejection was observed in the group of RA-ILD (11.1% vs 22.2%; p=0.45). Cumulative survival rates at 5 year post-transplant did no differ significantly between RA-ILD and IFP [61.0% vs 85.7% (p=0.27)] (FIGURE 1).
Conclusion: Patients who underwent lung transplantation for RA-ILD in our center showed a trend to lower long-term post-transplant survival than in those with IPF. This could be explained by an increased frequency of chronic graft rejection. However, in selected candidates, RA-ILD should not be considered a contraindication for lung transplantation.
To cite this abstract in AMA style:PRIETO- PENA D, Martinez Meñaca A, Calderón-Goercke M, Mora Cuesta V, Fernández Rozas S, Iturbe Fernandez D, Gonzalez-Mazon I, Sanchez-Bilbao L, Cifrian Martínez J, González-Gay M, Blanco R. Long-term Survival in Lung Transplantation and Allograft Rejection in Patients with Interstitial Lung Disease Related with Rheumatoid Arthritis: Study from a Single Referral Center [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/long-term-survival-in-lung-transplantation-and-allograft-rejection-in-patients-with-interstitial-lung-disease-related-with-rheumatoid-arthritis-study-from-a-single-referral-center/. Accessed December 5, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-survival-in-lung-transplantation-and-allograft-rejection-in-patients-with-interstitial-lung-disease-related-with-rheumatoid-arthritis-study-from-a-single-referral-center/